9 ASC Trends for 2026: What's Actually Moving the Needle

Key ASC Trends that Move the Needle

• Complex procedures are rapidly migrating to ASCs with CMS adding nearly two dozen procedural codes for 2025, while cardiovascular OR times dropped 28% and revenue per OR minute jumped 27%

• Alternative payment models are gaining ground as direct employer contracting and bundled payments challenge traditional fee-for-service, though less than 20% of Medicare spending currently ties to value-based care

• Operational excellence shows dramatic gains with ASC claim denial rates cut in half to 4% while smaller 2-OR centers outperform larger facilities with 22% growth

• The partial payment crisis demands new strategies as partial payments surged to 56.2% of cases, forcing ASCs to require pre-surgery payment or develop better financial assistance programs

• Technology adoption accelerates with AI-powered planning, robotic surgery, virtual reality education, and telemedicine becoming operational necessities rather than nice-to-haves

• Physicians are choosing ASCs over hospitals for guaranteed block time, ownership opportunities, and escape from health system consolidation, driving de novo development

• Regulatory barriers are falling with states like South Carolina and Tennessee eliminating CON requirements while New York and California prepare to approve cardiac procedures

• Facility designs are expanding from traditional 200-300 square foot ORs to 500-600 square feet, with 24-hour outpatient models emerging for higher-acuity cases

Why Are Complex Procedures Rapidly Moving to Surgery Centers?

The migration of complex procedures to ASCs isn't just continuing - it's accelerating.

CMS added nearly two dozen procedural codes to the ASC covered-procedures list in their 2025 final payment rule, signaling confidence in outpatient capabilities.

Cardiovascular procedures demonstrate just how dramatic this shift has become.

Average OR time dropped 28% - from 48 to 34.7 minutes between 2023 and 2024.

This efficiency gain translates directly to your bottom line, with revenue per OR minute jumping 27% to $132.88, even as per-case revenue declined slightly.

The procedures moving to ASCs would have seemed impossible just years ago.

Laminectomy and instrument fusions with pedicle screws spent decades as hospital-only procedures.

Now they're routine in outpatient settings.

Total knee and hip replacements have become ASC staples thanks to minimally invasive techniques.

Shoulder replacements are gaining momentum with a full year of outcome data proving ASCs can deliver excellent results.

Even more complex cases are making the jump.

Robotic cancer treatments, cardiac catheterizations, lumbar fusions, and cervical disc replacements are all finding homes in surgery centers.

The combination of advanced surgical techniques, improved anesthesia protocols, and refined post-operative recovery methods makes these transitions not just possible but preferable for many patients.

Beyond Fee-for-Service: Alternative Payment Models Gaining Traction

The payment landscape remains ripe for disruption.

Currently, less than 20% of Medicare spending connects to value-based models, and only 24.5% of all healthcare payments involve two-sided risk arrangements.

This gap represents opportunity.

ASCs are experimenting with models that align incentives differently.

CMS bundled payment programs and private-payer bundles for procedures like cataract surgeries and colonoscopies are gaining ground.

These arrangements reward efficiency and quality rather than volume.

The most interesting development might be direct employer contracting.

Self-funded employers are bypassing traditional insurance networks, sending employees directly to ASCs through specialty care networks.

One surgery center reports hundreds of contracts where employers fly employees for surgery and waive all out-of-pocket expenses - still saving money compared to local hospital pricing.

Shared-savings arrangements offer another path forward.

You collaborate with payers to reduce costs while maintaining quality standards, then keep a portion of the savings generated.

Large corporations increasingly pursue bundled payments specifically to highlight the efficiency and quality outcomes ASCs deliver.

What's Driving Operational Excellence?

The numbers tell a remarkable story of operational improvement.

While 75% of providers report rising claim denials industry-wide, ASCs cut their denial rates in half - from 8% in 2023 to just 4% in 2024.

This improvement stems from better documentation, improved coding accuracy, and early adoption of AI-powered revenue cycle tools.

Here's what might surprise you: smaller ASCs are outperforming larger ones.

Facilities with just two operating rooms saw 22% year-over-year growth, the highest of any size category.

Meanwhile, centers with 15 or more ORs experienced an 8% decline.

This "small is mighty" trend reflects the advantages of single-specialty focus - your staff becomes more knowledgeable, efficient, and targeted when they concentrate on one area.

Orthopedics continues setting the revenue standard with the highest average net revenue per case, climbing from $6,141 to $6,419.

Even with lower per-case revenues in some specialties, smart operational decisions drive profitability.

Cardiology exemplifies this - despite an 8% drop in revenue per case, the specialty's dramatic efficiency gains pushed revenue per OR minute up 27%.

The Partial Payment Crisis: How ASCs Are Adapting to Changing Collection Patterns

You can't ignore this trend: partial payments surged from 41.2% to 56.2% between 2023 and 2024, while full payments plummeted from 25.8% to just 17%.

This shift fundamentally changes how ASCs must approach collections.

The response has been swift and sometimes strict.

Some ASCs now require full payment before surgery - no payment, no procedure.

While this seems harsh, it prevents bad debt that can cripple margins.

Collecting payments pre-DOS (day of service) has become a critical operational strategy.

For ASCs taking a softer approach, the focus shifts to developing improved payment plans and financial assistance options.

The key is addressing collection challenges before they become write-offs.

You need systems that can handle payment complexity while maintaining patient satisfaction.

The Technology Revolution: AI, Robotics, and Digital Transformation in ASCs

Technology adoption in ASCs has moved from "nice to have" to operational necessity.

AI-powered software now analyzes patient data, assists with preoperative planning, and predicts potential complications before they occur.

Robotic systems deliver tangible benefits: greater precision, smaller incisions, and faster recovery times.

The next frontier involves autonomous surgical robots with AI algorithms that perform certain tasks independently under surgeon supervision.

This isn't science fiction - it's happening now in leading centers.

Patient-facing technology is equally transformative.

Virtual reality provides immersive education about complex procedures, helping reduce anxiety and improve informed consent.

Telemedicine handles remote consultations, preoperative evaluations, and post-operative follow-ups, expanding your reach without expanding your footprint.

Behind the scenes, integrated electronic health records enhance communication between providers, while advanced imaging systems and monitoring capabilities enable truly personalized patient care.

Remote observation tools and personalized recovery technologies are becoming standard features in modern ASCs.

The Great Migration: Why Physicians Are Choosing ASCs Over Hospitals

Physician burnout from the pandemic's aftermath and ongoing health system consolidation is driving an exodus to ASCs.

But it's not just about escaping problems - it's about finding better opportunities.

For established physicians, ASCs offer guaranteed block time, enabling faster patient scheduling and eliminating the wait time frustrations common in hospitals.

Those nearing retirement appreciate escaping on-call duties and the hospital grind while maintaining active practices.

Younger doctors are discovering the ASC value proposition includes ownership opportunities that let them control their professional destiny.

Unlike hospital employment, ASC ownership means physicians drive growth and success decisions directly.

The surge in de novo ASC development proves this isn't just talk.

Physicians are putting capital at risk to build new centers, demonstrating genuine belief in the model.

Spine surgeons, in particular, are increasingly embracing ASCs for their procedures, recognizing the operational advantages for their specialized needs.

Regulatory Wins: Which States Are Eliminating Barriers to ASC Growth?

Certificate of Need laws have long restricted ASC development, but the walls are coming down.

South Carolina eliminated CON requirements for ASCs in counties with populations over 125,000, effective November 21, 2024.

Tennessee's CON laws for ASCs will sunset completely in December 2027.

North Carolina and Georgia are implementing or planning similar changes to their ASC-related CON laws.

This regional shift in the Southeast could trigger nationwide reconsideration of these restrictive policies.

Procedure-specific wins matter too.

New York and California are on track to approve cardiac procedures for ASCs, opening massive new markets.

Industry observers expect a more aggressive CMS stance on moving procedures to ASCs under the current administration, potentially accelerating the regulatory loosening trend.

Consolidation Wave: How Investment Activity Is Transforming ASC Ownership

After three years of modest activity, private equity firms sit on significant dry powder - capital they must deploy or return to investors.

The 2024 deal count of 409 healthcare buyouts in North America and Europe, down from 515 in 2021, suggests pent-up demand for transactions.

Yet the consolidation story isn't straightforward.

Only 6% of ASC respondents plan to sell independently in 2025, but more than half are considering strategic partnerships.

When partnerships are on the table, 57% prefer health systems, while 30% would partner with private equity and 28% with management companies.

This selective approach to partnerships reflects ASC leaders' desire to maintain some autonomy while accessing resources for growth.

Larger healthcare systems and PE companies acquiring independent ASCs seek operational efficiencies and economies of scale that benefit both parties.

Facility Design Evolution: From Traditional ORs to 24-Hour Outpatient Models

Physical spaces are transforming to match procedural complexity.

OR sizes are expanding from 200-300 square feet to 500-600 square feet, accommodating robotic systems and advanced surgical equipment.

The emergence of 24-hour outpatient models represents a fundamental shift in ASC capabilities.

These facilities handle higher-acuity procedures requiring extended observation without full hospital admission.

Patients get the ASC experience with appropriate medical oversight.

Design changes extend beyond clinical spaces.

Separate entrances and exits for incoming and outgoing patients are becoming standard, improving flow and privacy.

Waiting areas now resemble private living rooms with residential furniture rather than institutional seating.

These investments align with growth projections showing a 12% increase in orthopedics/spine-focused ASCs within five years, and 22% over the next decade.

Natural lighting, soothing color palettes, and ergonomic furniture aren't just aesthetic choices - they're strategic investments in patient satisfaction and outcomes.

While You're Adding Complex Procedures, We're Eliminating 53% of Your No-Shows

You've just read about the massive shifts hitting ASCs this year - from complex procedure migration to the partial payment crisis where 56.2% of cases now involve partial payments.

Managing these changes while maintaining operational excellence feels overwhelming, especially when you're already dealing with staffing challenges and technology demands.

Here's what you might not realize: many of these operational headaches stem from one core issue - inefficient patient communication.

That's where Dialog Health comes in.

Our HIPAA-compliant two-way texting platform helps ASCs like yours tackle multiple challenges simultaneously.

Here's what ASCs using Dialog Health actually achieve:

• 53% reduction in no-show rates - imagine half your no-shows simply disappearing

• $100,000 revenue increase from a 34% no-show reduction

• 92% fewer post-operative phone calls freeing your staff for actual patient care

• 54% increase in cash flow using our SMS features for payment collection

• 66% decrease in same-day cancellations giving you time to fill those slots

See our Case Studies

With payment collections becoming increasingly complex, our automated reminders and two-way conversations help you address payment issues before surgery day.

We're talking about real results from ASCs facing the exact challenges you're navigating right now.

Here's what happens next: Fill out this quick form and one of our healthcare communication experts will reach out to schedule a brief 15-minute video call at your convenience.

We've done this thousands of times with ASCs just like yours, and you'll get all the information you need - no pressure, just answers about how two-way texting can solve your specific challenges.